This is a joint statement from the American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation.
Background:
As the Covid pandemic continues, they wanted to determine the surgical risk for patients who are doing elective surgery procedures. As a plastic surgeon, almost 100% of my surgery is elective (that means you don’t *need* surgery, like you do when you have appendicitis or a broken bone.).
Why did they produce this statement?
We know Covid 19 involves all major organ systems. They want to lower the risk of postoperative complications. They refer to many studies. One study showed significantly higher risk of lung complications within the first four weeks after Covid diagnosis. Patients with diabetes were more likely to have severe Covid and more likely to be hospitalized.
Their recommendations:
- All non urgent procedures should be delayed until the patient has met criteria to discontinue isolation for Covid and has entered the recovery phase. They should no longer be infectious. (Infectious period is generally about 10 days after symptom onset for those with mild to no symptoms). This means also at least 24 hours have passed since last fever without using fever reducing medications, and all symptoms- cough, shortness of breath- have improved.
- PATIENTS WITH NO SYMPTOMS, with a positive Covid test, should not do surgery for ONE MONTH.
- PATIENTS WITH MILD SYMPTOMS, meaning no pneumonia or oxygen saturation below 94%, and who have not been hospitalized, should not do elective surgery for 6 WEEKS after.
- PATIENTS WITH SEVERE ILLNESS, meaning pneumonia, hypoxic respiratory failure, septic shock), or those who are hospitalized. should not do surgery for 8 – 10 WEEKS after illness. This includes patients who are diabetic or immunocompromised.
- PATIENTS WHO WERE IN THE ICU need 12 WEEKS prior to elective surgery.
These guidelines are guidelines. They should be adjusted if needed. Other considerations:
- Those patients who are severely immunocompromised should be evaluated using a different metric.
- Other factors: advanced age, diabetes, end stage kidney disease should also be considered.
- If there are RESIDUAL SYMPTOMS like fatigue, shortness of breath, and chest pain.
- Covid 19 may have a long term bad effect on the heart function.
For these patients, there should be a more in depth evaluation of heart and lung issues if they still have any symptoms.
My thoughts?
Elective surgery is by definition not needed. The most important thing we can do is to optimize for a safe surgery. I think these guidelines are important.